Forms for Employers

These forms are in portable document format (PDF). You may print and copy as needed.

Note:

  • Groups that submit eligibility electronically or on paper may use these forms.
  • Groups that submit electronic enrollment must submit changes to membership information electronically.
  • The employee enrollment applications are for use by groups that submit paper enrollment forms only.

Health Advantage Group Administrators

Arkansas State Employees/Public School Personnel Group Administrators